Relationship Between Hours of CPAP Use and Achieving Normal Levels of Sleepiness and Daily Functioning
Open accessAbstract
STUDY OBJECTIVES: Evidence suggests that, to maintain treatment effects, nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) needs to be used every night. What remains unknown is the nightly duration of use required to normalize functioning. This study, employing probit analyses and piecewise regression to estimate dose-response functions, estimated likelihoods of return to normal levels of sleepiness and daily functioning relative to nightly duration of CPAP. DESIGN: Multicenter, quasi-experimental study. SETTING: Seven sleep centers in the United States and Canada. PARTICIPANTS: Patients with severe OSA (total cohort n = 149; the numbers of included participants from 85 - 120, depending on outcome analyzed.) INTERVENTIONS: CPAP. MEASUREMENTS AND RESULTS: Before treatment and again after 3 months of therapy, participants completed a day of testing that included measures of objective and subjective daytime sleepiness and functional status. There were significant differences in mean nightly CPAP duration between treatment responders and nonresponders across outcomes. Thresholds above which further improvements were less likely relative to nightly duration of CPAP were identified for Epworth Sleepiness Scale score (4 hours), Multiple Sleep Latency Test (6 hours), and Functional Outcomes associated with Sleepiness Questionnaire (7.5 hours). A linear dose-response relationship (P < 0.01) between increased use and achieving normal levels was shown for objective and subjective daytime sleepiness, but only up to 7 hours use for functional status. CONCLUSIONS: Our analyses suggest that a greater percentage of patients will achieve normal functioning with longer nightly CPAP durations, but what constitutes adequate use varies between different outcomes.
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Current evidence suggests a continuous dose-response relationship between hours of PAP use and therapeutic response.
“current evidence suggests a continuous dose-response relationship between hours of use and therapeutic response.22,23”
From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [23]
The Discussion (page not specified in our copy) reports continuous gains in objective and subjective sleepiness with longer nightly CPAP use. It also says functional status appears to gain no further benefit beyond seven hours, so a continuous dose-response relationship does not apply to every therapeutic outcome studied. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe incremental improvements achieved with one extra hour of CPAP treatment are small.
“While more time spent using CPAP leads to greater improvement in secondary manifestations of OSA such as sleepiness and quality of life, the incremental improvements achieved with one extra hour of CPAP treatment are small [49,50].”
From Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: A randomized clinical trial (2019) · cites this paper as [49]
The CPAP Dose Response and Functional Status results (pages unavailable in our copy) report incremental associations of 0.90 ESS points and 0.33 FOSQ points per additional nightly hour, consistent with modest changes on those measures. But the Discussion calls the differences in CPAP use between participants who did and did not reach normal outcomes “moderate and clinically meaningful”; the paper does not characterize the benefit of an extra hour as uniformly small. (LLM, conf=0.79)
Experimental — accuracy not yet measuredOne study found a linear dose-response relationship between more CPAP use and better outcomes up through 7 hours of use.
“One study found that more CPAP use was associated with better outcomes, finding a linear dose–response relationship up through 7 h of use.1098”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [1098]
Experimental — accuracy not yet measuredMore time spent using CPAP leads to greater improvement in secondary manifestations of OSA such as sleepiness and quality of life.
“While more time spent using CPAP leads to greater improvement in secondary manifestations of OSA such as sleepiness and quality of life, the incremental improvements achieved with one extra hour of CPAP treatment are small [49,50].”
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Westlake, K., Dostalova, V., Plihalova, A., Pretl, M., & Polak, J. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00714 · Cited by 11 · see citing works
Nilius, G., Cottin, U., Domanski, U., van’t Hoog, T., Franke, K.-J., Burian, S., & Ruehle, K.-H. (2012) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-012-0580-y · Cited by 10 · see citing works
Brown, L. K. (2010) · Chest · doi:10.1378/chest.10-1168 · Cited by 9 · see citing works
Fietze, I., Blum, H.-C., Grüger, H., Käßner, F., Maurer, J. T., Nilius, G., Penzel, T., Triché, D., & Arzt, M. (2021) · Somnologie · doi:10.1007/s11818-021-00305-9 · Cited by 7 · see citing works
- Authors
- Weaver, T. E., Maislin, G., Dinges, D. F., Bloxham, T., George, C. F. P., Greenberg, H., Kader, G., Mahowald, M., Younger, J., & Pack, A. I.
- Affiliations
- University of Pennsylvania (US)
- Western University (CA)
- Northwell Health (US)
- Hennepin County Medical Center (US)
- Corresponding author
- Weaver, Terri E.
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-06
- Volume
- 30
- Issue
- 6
- Pages
- 711-719
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC1978355
- OpenAlex
- W152319107
- Semantic Scholar
- 0e1c7b12c1d9d44ad7b6d56fccd49655f9f5cc9a
- Cited by
- 1,058
- References
- 39
- Citations by year
- 2026: 34 · 2025: 46 · 2024: 54 · 2023: 75 · 2022: 95 · 2021: 96 · 2020: 76 · 2019: 60 · 2018: 51 · 2017: 59 · 2016: 62 · 2015: 61 · 2014: 55 · 2013: 43 · 2012: 39
- FWCI
- 22.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Sanofi
- University of Pennsylvania
- Hennepin County Medical Center
- Jazz Pharmaceuticals
- National Heart, Lung, and Blood Institute
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Keywords
- CPAP adherence, continuous positive airway pressure, obstructive sleep apnea, daytime sleepiness, functional status, dose-response relationship, Epworth Sleepiness Scale, multiple sleep latency test
- MeSH terms
- Adult, Circadian Rhythm, Female, Humans, Disorders of Excessive Somnolence, Male, Middle Aged, Patient Compliance, Surveys and Questionnaires, Severity of Illness Index, Polysomnography, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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